A new application of ultrasonography has been emerging in the bone quantitative ultrasound arena in the last twenty years: cortical bone characterization using axial transmission ultrasound (ATU). Although challenged by the complicated cortical tissue-ultrasonic wave interaction, ATU has proved to have promising potential to be a valuable diagnostic tool in the assessment of cortical bones. This chapter reviews the main landmarks of axial transmission signal processing in the past decade to provide a guide to the diversity of available techniques. In order to increase the readability of the chapter, the signal processing methods are categorized based on the experimental settings: single and multiple transmitter-receiver configuration. The review considers the key stages required for the analysis of bone guided-wave ultrasound data namely dispersion energy imaging, modal filtering, dispersion curve inversion, and measurement automation with integrated artificial intelligence concepts. Besides discussing the recent signal processing advances in the field of bone assessment by axial transmission, this communication offers developments that might be anticipated in the near future.
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